Introduction: There are two surgical approaches to reconstruct a pressure ulcer (PU): one-stage reconstruction or two-stage reconstruction. One stage reconstruction consists of surgical debridement and flap reconstruction during one operation. Two-stage surgery consist of a surgical debridement and a final reconstruction in two different sessions, with approximately six weeks between both sessions. Objective: The aim of this study was to compare the results of single stage surgery and two-stage surgery on the PU recurrence rate and other important post operative complications. Method: A retrospective, comparative study in Spinal Cord Injured (SCI) individuals with a single- or two stage surgical reconstruction between 2005 and 2016 was designed. A total of 81 records were included for analysis. Results: The primary outcome, the difference in occurrence of a recurrent PU in the reconstructed area (33.3% versus 31.6%), is not statistically significant between one-and two-stages reconstruction. Also, the mean duration to develop a recurrent PU between both surgical reconstructions is not statistically significant. Other surgical complications in the reconstructed area like wound hematoma, hemorrhage, seroma or (partial) flap failure did not differ significantly between both groups, apart and in total. We calculated the additional costs in case of a two-stage approach compared with a single-stage reconstruction at EUR 16,362. Conclusions: There are no statistical significant differences in PU recurrence rate or other post operative complications between SCI patients who have undergone one- or two stage PU reconstructive surgery. The most obvious choice for a one-stage approach in case of PU reconstructive surgery has great positive implications for the patient, family, health care providers and the health care system.
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Breast cancer is the most prevalent form of cancer that affects women worldwide, posing a significant burden on public health. While advancements in early detection and improved treatments have led to a remarkable 90% five-year survival rate and an 83% ten-year survival rate, this has also resulted in more prophylactic mastectomies being performed. Despite advancements in breast-conserving techniques, immunotherapy, and hormone therapy, many women still undergo mastectomies as part of their cancer treatment. In all cases, this results in scarring, and additional side effects from treatment modalities may arise. The loss of a breast can profoundly impact health-related quality of life (HRQoL). Although HRQoL has improved greatly during the recent years, systematic and local therapy having side effects is not uncommon, and this needs more attention.
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Purpose: This research aimed to explore factors associated with patient-reported breast and abdominal scar quality after deep inferior epigastric perforator (DIEP) flap breast reconstruction (BR). Material and Methods: This study was designed as a descriptive cross-sectional survey in which women after DIEP flap BR were invited to complete an online survey on breast and abdominal scarring. The online survey was distributed in the Netherlands in several ways in order to reach a diverse population of women. Outcomes were assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Additional items were assessed with a numeric rating scale (NRS). Results: A total of 248 women completed the survey. There was a statistically significant worse POSAS scar appraisal for the abdominal scar compared with the breast scar. The vast majority of women reported high scores on at least one scar characteristic of their breast scar or ab- dominal scar. Overall, color, stiffness, thickness, and irregularity scored higher than pain and itching. Women were only moderately positive about the size, noticeability, location, and the information provided regarding scarring. Conclusion: It is crucial to address the inevitability of scars in patient education before a DIEP flap BR, with a particular focus on the abdominal scar, as women experience abdominal scars significantly worse than their breast scars. Providing more information on the experience of other women and the expected appearance will contribute to having realistic expectations while allowing them to make well-informed decisions.
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Structural Biology plays a crucial role in understanding the Chemistry of Life by providing detailed information about the three-dimensional structures of biological macromolecules such as proteins, DNA, RNA and complexes thereof. This knowledge allows researchers to understand how these molecules function and interact with each other, which forms the basis for a molecular understanding of disease and the development of targeted therapies. For decades, X-ray crystallography has been the dominant technique to determine these 3D structures. Only a decade ago, advances in technology and data processing resulted in a dramatic improvement of the resolution at which structures of biomolecular assemblies can be determined using another technique: cryo-electron microscopy (cryo-EM). This has been referred to as “the resolution revolution”. Since then, an ever increasing group of structural biologists are using cryo-EM. They employ a technique named Single Particle Analysis (SPA), in which thousands of individual macromolecules are imaged. These images are then computationally iteratively aligned and averaged to generate a three-dimensional reconstruction of the macromolecule. SPA works best if a very pure and concentrated macromolecule of interest can be captured in random orientations within a thin layer (10-50nm) of vitreous ice. Maastricht University has been the inventor of the machine that is found in most labs worldwide used for this: the VitroBot. We have been the inventor of succeeding technologies that allow for much better control of this process: the VitroJet. In here, we will develop a novel chemical way to expand our arsenal for preparing SPA samples of defined thickness. We will design, produce and test chemical spacers to allow for a controlled sample thickness. If successful, this will provide an easy, affordable solution for the ~1000 laboratories worldwide using SPA, and help them with their in vitro studies necessary for an improved molecular understanding of the Chemistry of Life.
